Environmental Drivers of Ranavirus in Free-Living Amphibians in Constructed Ponds

Amphibian ranaviruses occur globally, but we are only beginning to understand mechanisms for emergence. Ranaviruses are aquatic pathogens which can cause?>?90% mortality in larvae of many aquatic-breeding amphibians, making them important focal host taxa. Host susceptibilities and virulence of ranaviruses have been studied extensively in controlled laboratory settings, but research is needed to identify drivers of infection in natural environments. Constructed ponds, essential components of wetland restoration, have been associated with higher ranavirus prevalence than natural ponds, posing a conundrum for conservation efforts, and emphasizing the need to understand potential drivers. In this study, we analyzed 4 years of Frog virus 3 prevalence and associated environmental parameters in populations of wood frogs (Lithobates sylvaticus) and green frogs (Lithobates clamitans) in a constructed pond system. High prevalence was best predicted by low temperature, high host density, low zooplankton concentrations, and Gosner stages approaching metamorphosis. This study identified important variables to measure in assessments of ranaviral infection risk in newly constructed ponds, including effects of zooplankton, which have not been previously quantified in natural settings. Examining factors mediating diseases in natural environments, particularly in managed conservation settings, is important to both validate laboratory findings in situ, and to inform future conservation planning, particularly in the context of adaptive management.     

A Global Review of Causes of Morbidity and Mortality in Free-Living Vultures

Vulture species worldwide play a key role in ecosystems as obligate scavengers, and several populations have had precipitous declines. Research on vulture health is critical to conservation efforts including free-living vultures and captive breeding programs, but is limited to date. In this systematic review, we determined the reported causes of free-living vulture species morbidity and mortality worldwide. The most commonly reported cause of mortality was from toxins (60%), especially lead and pesticides, followed by traumatic injury (49%), including collisions with urban infrastructure and gunshot. Neglected areas of research in free-living vulture health include infectious diseases (16%), endocrine and nutritional disorders (6%), and neoplasia (<?1%). Almost half of the studies included in the review were conducted in either Spain or the USA, with a paucity of studies conducted in South America and sub-Saharan Africa. The highest number of studies was on Griffon (Gyps fulvus) (24%) and Egyptian vultures (Neophron percnopterus) (19%), while half of all vulture species had five or fewer studies. Future investigations on free-living vulture health should focus on neglected areas of research, such as infectious diseases, and areas with gaps in the current literature, such as South America, sub-Saharan Africa, and under-studied vulture species.

     

Causes of Morbidity and Mortality in Free-Living Birds in an Urban Environment in Germany

Free-living birds are often presented to veterinarians at rehabilitation centers as well as in private practice. Information about disease processes and causes of death of indigenous free-living birds can aid the clinician in establishing proper treatment and in the assessment of potential zoonotic risks. For the present study, pathogens as causes of morbidity and mortality were determined by performing a complete necropsy on free-living birds presented to the Clinic for Birds and Reptiles of the University of Leipzig (Germany) that died shortly after admission or were euthanized due to an unfavorable prognosis. Over a 2-year period, 251 birds representing 13 families (Accipitridae, Apodidae, Columbidae, Corvidae, Falconidae, Fringillidae, Hirundinidae, Paridae, Passeridae, Picidae, Strigidae, Sturnidae and Turdidae) were examined. Trauma (62%), including several bite injuries inducing bacterial septicemia caused by Pasteurella multocida, was the most common cause of morbidity. Parasitic disease (18%) was mainly caused by Trichomonas gallinae, Eucoleus dispar and Syngamus trachea. Metabolic disease (13%), including fibrous osteodystrophy, was almost exclusively limited to juvenile specimens. Different Enterobacteriaceae including E. coli, Salmonella Typhimurium DT040 as well as Mycobacterium avium ssp. avium were identified as causal agents of primary bacterial disease (5%). Primary bacterial infection as cause of death or disease was of major importance in nestlings. Viral infections, mycoses and intoxication had minor significance as causes of morbidity.     

Morbidity and Mortality of Invertebrates,Amphibians, Reptiles,and Mammals at a Major Exotic Companion Animal Wholesaler

The authors formally investigated a major international wildlife wholesaler and subsequently confiscated more than 26,400 nonhuman animals of 171 species and types. Approximately 80% of the nonhuman animals were identified as grossly sick, injured, or dead, with the remaining in suspected suboptimal condition. Almost 3,500 deceased or moribund animals (12% of stock), mostly reptiles, were being discarded on a weekly basis. Mortality during the 6-week “stock turnover” period was determined to be 72%. During a 10-day period after confiscation, mortality rates (including euthanasia for humane reasons) for the various taxa were 18% for invertebrates, 44.5% for amphibians, 41.6% for reptiles, and 5.5% for mammals. Causes of morbidity and mortality included cannibalism, crushing, dehydration, emaciation, hypothermic stress, infection, parasite infestation, starvation, overcrowding, stress/injuries, euthanasia on compassionate grounds, and undetermined causes. Contributing factors for disease and injury included poor hygiene; inadequate, unreliable, or inappropriate provision of food, water, heat, and humidity; presumed high levels of stress due to inappropriate housing leading to intraspecific aggression; absent or minimal environmental enrichment; and crowding. Risks for introduction of invasive species through escapes and/or spread of pathogens to naive populations also were identified.     

Mortality and Morbidity of Exchange Transfusion

One hundred and fifty exchange transfusions, using citrated donor blood, were investigated to determine the mortality rate from the procedure. One infant died during manipulation of the catheter in the umbilical vein. Four infants died of combined causes including anemia, prematurity and elevated potassium in the donor blood. Sixty-two exchange transfusions were investigated in detail to determine the incidence of clinical disturbances. Vomiting, retching, respiratory distress, convulsions or tetany developed during 23 exchanges. A rapid rate of exchange, elevated potassium in the donor blood, and failure to administer calcium during the exchange were major factors contributing to these disturbances. Exchange transfusion with citrated blood can be safeguarded by (1) using donor blood less than five days old, (2) employing a rate of exchange of 2 ml./kg./min. and (3) injecting calcium gluconate during the exchange.     

Serum Creatinine Modifies Associations between Body Mass Index and Mortality and Morbidity in Prevalent Hemodialysis Patients

Background

High body mass index (BMI) is paradoxically associated with better outcomes in hemodialysis (HD) patients. This study aimed to examine whether serum creatinine (Cr), a marker of muscle mass, could modify the association between BMI, and mortality and morbidity in prevalent HD patients.

Methods

A retrospective study was conducted using a nationwide database from the registry of the Japanese Society for Dialysis Therapy. A total of 119,099 patients were selected (age: 65±12 years; median time on HD: 5.6 years; male: 62%), and we examined the association of basal BMI with mortality and morbidity after a 1-year period. Patients were stratified either by BMI into 4 groups or by serum Cr levels into 3 tertiles. Odds ratio (OR) [95% confidence interval] was calculated by multivariate logistic regression analysis.

Results

Higher BMI did not predict a higher 1-year total mortality. However, when we stratified the patients by serum Cr levels, the risk of cardiac death became significantly higher in obese patients with the lowest Cr levels, in both males (OR 2.82 [1.51–5.27], p<0.01) and females (OR 2.00 [1.03–3.90], p<0.05). The risk of new cerebral infarction was also higher in obese male patients within the lowest Cr tertile. In contrast, there was a significantly lower risk of cardiac, cerebrovascular, and infection-related death in non-obese patients with higher levels of Cr. Higher serum Cr was also related to a lower risk of cardiovascular events and hip fracture in non-obese HD patients.

Conclusions

The obesity paradox was found to be present in HD patients only when obesity was defined by BMI. Decreased serum Cr levels were found to be positively associated with clinical poor outcomes in all BMI groups. Thus, irrespective of BMI, the evaluation of serum Cr levels is important to predict mortality and morbidity in patients receiving regular HD.     

Barbiturate Intoxication: Morbidity and Mortality

The complications encountered in caring for 185 patients intoxicated with barbiturates were reviewed. The population consisted of 142 patients with long-acting barbiturate concentrations of 8 mg per 100 ml or greater, 20 patients with short-acting barbiturate concentrations of 3 mg per 100 ml or greater and 23 consecutive patients with short-acting barbiturate intoxication referred for monitoring. Pneumonia was the major cause of morbidity and mortality and correlated best with the initial depth of coma and the use of an endotracheal tube in treatment. Cardiovascular instability manifested by pulmonary edema was the next leading cause of morbidity and mortality and correlated best with the initial depth of coma and the quantity of intravenous fluid administered. In retrospect, use of eliminative measures such as dialysis would probably not have altered the outcome in most of the patients who died and attempts at forced diuresis may have contributed to several deaths. Particular emphasis should be placed on the problems of sepsis and fluid therapy in the management of these patients.     

Hip Circumference and Cardiovascular Morbidity and Mortality in Men and Women

Objective: It has recently been demonstrated that, in middle‐aged women, a wide hip circumference is a protective factor for a number of health endpoints in later years. The effect seems to be independent of both overweight and waist circumference. This paper aims to replicate this finding in another population‐based sample consisting of women and men. Research Methods and Procedures: This was a prospective observational study consisting of a random subset of adult Danes. A total of 2987 subjects born in 1922, 1932, 1942, or 1952 and 35, 45, 55, or 65 years of age (at examination in 1987 to 1988) participated in the Danish MONICA (MONItoring trends and determinants of CArdiovascular disease) project, with measurements of height, weight, and hip and waist circumference taken. Through personal identification numbers, incidence of coronary heart disease (CHD) and cardiovascular disease (CVD) until the end of 1998 and all causes of death until 2001 were retrieved from the National Registers of Hospital Discharge. There was an average of 10 years of follow‐up for incidence of CVD and CHD and 13 years of follow‐up for total mortality. Results: Large hip circumference, relative to body size and waist circumference, predicted less incidence of CVD, CHD, and total death in women. This was not the case in men; BMI and waist circumference were the strongest independent predictors. Discussion: A large hip circumference seems to have independent and positive effects on CVD and CHD morbidity and mortality in women, but no protective effect on cardiovascular health in men. However, a borderline significant protective effect on total mortality was observed.     

Mortality Rates Differ Among Amphibian Populations Exposed to Three Strains of a Lethal Ranavirus

Infectious diseases are a growing threat to biodiversity, in many cases because of synergistic effects with habitat loss, environmental contamination, and climate change. Emergence of pathogens as new threats to host populations can also arise when novel combinations of hosts and pathogens are unintentionally brought together, for example, via commercial trade or wildlife relocations and reintroductions. Chytrid fungus (Batrachochytrium dendrobatidis) and amphibian ranaviruses (family Iridoviridae) are pathogens implicated in global amphibian declines. The emergence of disease associated with these pathogens appears to be at least partly related to recent translocations over large geographic distances. We experimentally examined the outcomes of novel combinations of host populations and pathogen strains using the amphibian ranavirus Ambystoma tigrinum virus (ATV) and barred tiger salamanders (Ambystoma mavortium, formerly considered part of the Ambystoma tigrinum complex). One salamander population was highly resistant to lethal infections by all ATV strains, including its own strain, and mortality rates differed among ATV strains according to salamander population. Mortality rates in novel pairings of salamander population and ATV strain were not predictable based on knowledge of mortality rates when salamander populations were exposed to their own ATV strain. The underlying cause(s) for the differences in mortality rates are unknown, but local selection pressures on salamanders, viruses, or both, across the range of this widespread host–pathogen system are a plausible hypothesis. Our study highlights the need to minimize translocations of amphibian ranaviruses, even among conspecifc host populations, and the importance of considering intraspecific variation in endeavors to manage wildlife diseases.     

Global Morbidity and Mortality of Leptospirosis: A Systematic Review

BackgroundLeptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis is a life-threatening disease and recognized as an important cause of pulmonary haemorrhage syndrome, the lack of global estimates for morbidity and mortality has contributed to its neglected disease status.Conclusions/SignificanceLeptospirosis is among the leading zoonotic causes of morbidity worldwide and accounts for numbers of deaths, which approach or exceed those for other causes of haemorrhagic fever. Highest morbidity and mortality were estimated to occur in resource-poor countries, which include regions where the burden of leptospirosis has been underappreciated.     

Individual- and Neighborhood-Level Predictors of Mortality in Florida Colorectal Cancer Patients

Purpose

We examined individual-level and neighborhood-level predictors of mortality in CRC patients diagnosed in Florida to identify high-risk groups for targeted interventions.

Methods

Demographic and clinical data from the Florida Cancer Data System registry (2007–2011) were linked with Agency for Health Care Administration and US Census data (n = 47,872). Cox hazard regression models were fitted with candidate predictors of CRC survival and stratified by age group (18–49, 50–64, 65+).

Results

Stratified by age group, higher mortality risk per comorbidity was found among youngest (21%), followed by middle (19%), and then oldest (14%) age groups. The two younger age groups had higher mortality risk with proximal compared to those with distal cancer. Compared with private insurance, those in the middle age group were at higher death risk if not insured (HR = 1.35), or received healthcare through Medicare (HR = 1.44), Medicaid (HR = 1.53), or the Veteran’s Administration (HR = 1.26). Only Medicaid in the youngest (52% higher risk) and those not insured in the oldest group (24% lower risk) were significantly different from their privately insured counterparts. Among 18–49 and 50–64 age groups there was a higher mortality risk among the lowest SES (1.17- and 1.23-fold higher in the middle age and 1.12- and 1.17-fold higher in the older age group, respectively) compared to highest SES. Married patients were significantly better off than divorced/separated (HR = 1.22), single (HR = 1.29), or widowed (HR = 1.19) patients.

Conclusion

Factors associated with increased risk for mortality among individuals with CRC included being older, uninsured, unmarried, more comorbidities, living in lower SES neighborhoods, and diagnosed at later disease stage. Higher risk among younger patients was attributed to proximal cancer site, Medicaid, and distant disease; however, lower SES and being unmarried were not risk factors in this age group. Targeted interventions to improve survivorship and greater social support while considering age classification may assist these high-risk groups.